25 February 2013
USA: Training in miscarriage management
The purpose of this study was to test the impact of the Residency Training Initiative in Miscarriage Management on self-reported use of MVA for management of spontaneous abortion. From Family Medicine.
The authors note that non-complicated spontaneous abortion cases should be counseled about the full range of management approaches, including uterine evacuation using manual vacuum aspiration (MVA). The Residency Training Initiative in Miscarriage Management (RTI-MM) is an intensive, multidimensional intervention designed to facilitate implementation of office-based management of spontaneous abortion using MVA in family medicine residency settings. The purpose of this study was to test the impact of the RTI-MM on self-reported use of MVA for management of spontaneous abortion.
The authors used a pretest/posttest one group study design and a web-based, anonymous survey to collect data on knowledge, attitudes, perceived barriers, and practice of office-based management of spontaneous abortion. They used multivariable models to estimate incident relative risks and accounted for data clustering at the residency site level.
The sample included 441 residents and faculty from 10 family medicine residency sites. The findings show a positive association between the RTI-MM and self-reported use of MVA for management of spontaneous abortion (adjusted RR=9.11 [CI=4.20—19.78]) and were robust to model specification. Male gender, doing any type of management of spontaneous abortion (eg, expectant, medication), other on-site reproductive health training interventions, and support staff knowledge scores were also significant correlates of physician practice of MVA.
The authors concluded that their findings suggest that the RTI-MM was successful in influencing the practice of management of spontaneous abortion using MVA in this population and that support staff knowledge may impact physician practice. Integrating MVA into family medicine settings would potentially improve access to evidence-based, comprehensive care for women.
Department of Medical Informatics and Clinical Epidemiology and Department of Obstetrics and Gynecology, Oregon Health & Science University.
The family medicine residency training initiative in miscarriage management: impact on practice in Washington State. Darney BG, Weaver MR, Stevens N, Kimball J, Prager SW. Family Medicine. 2013 Feb;45(2):102-8.